Providers warn coronavirus is straining Connecticut’s safety net

Connecticut’s social services safety net is bracing for a double-whammy as the coronavirus crisis intensifies.

Dozens of nonprofit group homes are preparing emergency quarantine scenarios — if necessary — as they struggle to maintain residential services for the developmentally disabled, the mentally ill, drug addicts and others.

At the same time, hundreds of community-based agencies could soon find themselves hemorrhaging cash — some more than $1 million per month — if the pandemic forces a broad-based shutdown of daily programs.

“We’re working with some people who have to receive services — we cannot close,” said Heather Gates, president and CEO of Windsor-based Community Health Resources. “And that makes it a very scary time. The general level of fright in the community is high.”

Gates’ nonprofit serves about 27,000 people annually, treating the mentally ill, patients with drug addictions, and children with behavioral health needs. Community Health Resources operates group homes with a total of 102 beds and methadone clinics in Enfield, Putnam and in three prisons.

And while the clinics have some ability to send patients home with multiple methadone doses — and have special hygiene and social distancing protocols that pre-date the COVID-19 crisis — closing these operations isn’t realistic, Gates said.

Simply put: opioid addiction doesn’t care about the coronavirus outbreak.

“If somebody is already in treatment, we absolutely cannot discontinue services,” Gates said Wednesday, adding that Community Health Resources had no positive cases of COVID-19 at any of its homes or facilities.

Group homes must consider quarantine scenarios

If a client or staffer at a group home shows flu-like symptoms, the state Department of Public Health mandate is to isolate those individuals immediately, seek medical help and testing, and notify DPH.

Heather Gates, president of the mental health agency Community Health Resources

But ultimately, it could leave patients and staff quarantined in the group home.

The Department of Correction sent an individual transitioning from prison to a nonprofit-run halfway house in New Haven to Yale-New Haven Hospital on Wednesday after exhibiting flu-like symptoms. DOC spokesman Andrius Banevicius said Thursday this person did not test positive for COVID-19.

But things get even trickier for those serving the developmentally disabled.

Developmentally disabled adults can’t be sent to live with elderly parents

What happens if people who cannot be left unsupervised need to be quarantined?

“We are aware of some of the particular challenges these facilities face and we’re working as hard as we can to provide the right guidance,” said Department of Public Health spokesman Av Harris.

Jane Davis, president and CEO of Ability Beyond, said Wednesday her facilities also had no confirmed cases of COVID-19. But the Bethel-based nonprofit, which provides residential and day services for about 3,000 developmentally disabled clients, recently procured extra air mattresses and sheets.

If the pandemic hits the developmentally disabled, someone needs to stay with them. And many in group homes are there because their parents have died, or are too elderly to care for them. Couple this with CDC warnings that senior citizens are most vulnerable to the coronavirus and the challenge for nonprofits like Ability Beyond is even harder.

State agencies, in general, have been helpful, Davis said, but sometimes they can’t provide official guidance quickly.

“We’re trying to stay ahead of the guidance and do what we think is right. … Our staff is committed and they’re going to do the right thing for the people that we serve.”

Department on Developmental Services spokesman Kathryn Rock-Burns said the agency has been in regular contact with clients, their families, providers and others to resolve “an extraordinary volume of questions,” adding it has posted important COVID-19 information on its website.

“We’re working with some people who have to receive services — we cannot close. And that makes it a very scary time. The general level of fright in the community is high.”

Heather Gates
President/CEO of Community Health Resources

“We are highly sensitive to the fact that our private sector partners are caring for some of the state’s most vulnerable individuals and must be supported to the best of the state’s ability in these unprecedented circumstances,” she added.

DDS requires all providers it hires to develop Continuity of Operations protocols, and mandated earlier this month that updated plans be submitted to the state.

For example, most group homes are familiar with quarantine, dealing annually with influenza, but nothing approaching the severity of COVID-19.

“We’re at least always prepared for this type of thing, but not at this scale,” Davis said.

The chairwoman of Connecticut’s association of nonprofit independent living centers, agreed.

“We’ve generally gotten good information from DSS [the Department of Social Services]” but it’s more complicated than that, said Eileen Healy, who also is executive director of one of the centers, Independence Northwest in Naugatuck.

How does the center help seniors transition from a nursing home to independent living when the law requires them to line up a doctor’s appointment within three days of going home? Healy asked. 

How can they set up seniors with basic living supplies — as required — when toilet paper is not available? Healy noted that center staff have been providing their own bathroom and cleaning supplies to fulfill this need.

The five centers — the other four are in Hartford, New Haven, Norwich and Stratford — are hired by the state to advocate for the disabled, the mentally ill, the elderly and people living with HIV. Center staff help more than 13,000 people per year obtain housing, education, employment, and access technology and other services.

Nonprofits could hemorrhage cash if services close

And underlying all of these logistical challenges is a larger threat, nonprofit leaders said — a financial crash.

Many nonprofit social service agencies already are living on a shoestring, struggling with job vacancies and annual turnover rates in excess of 20% that stem largely from two decades of limited state funding.

The nonprofit sector provides the bulk of state-sponsored social services, and public contracts for these services total about $1.4 billion per year. In terms of dollars, that’s larger than the departments of Transportation, Correction and Motor Vehicles combined.

Since 2002, state spending for nonprofits has grown by about 10%.  After adjusting for inflation, nonprofits say they have lost money over that period.

The industry appealed, unsuccessfully, to Gov. Ned Lamont and the legislature in 2019 and again this year for additional operating funds.

Lamont and lawmakers did include $25 million per year in the two-year bond package approved earlier this month to help nonprofits with capital costs. But this is a fraction of the industry estimate, which says state funding is about $460 million below the annual level needed to maintain services.

What happens if day services and some residential programs are forced to close — a realistic prospect in the current public health crisis?

Gates, who runs one of Connecticut’s largest nonprofit social services agencies with an annual budget of about $63 million, said she stands to lose about $1 million per month.

Davis said the hit could be as large as $3.5 million per month. Her estimate also takes into account fundraising efforts, which also had to be suspended because of the pandemic.

Gian-Carl Casa, president and CEO of the CT Community Nonprofit Alliance, praised the Lamont administration for temporarily boosting payments to nonprofits serving the developmentally disabled by as much as 25%.

Connecticut expects to receive as much as $440 million in emergency Medicaid funding from a bill adopted by Congress on Wednesday night, and nonprofit leaders say some of that should come their way.

But there will be many competing needs for those dollars, with hospitals expected to stake the largest claim, and nursing homes also looking for assistance.

Chris McClure, a spokesman for the governor’s budget office, said it’s premature to discuss how those dollars might be divided. “However, we are hopeful that this infusion of capital will allow Connecticut to respond to the changing dynamic this situation requires,” he said. “… This is a pandemic, affecting everyone, and we appreciate the additional federal support to assist in these uncertain times.”

But Casa added that while “nonprofits are experts at creativity” the social services safety net has weaknesses that have been years in the making.

“This is a problem that goes back at least one, maybe two decades,” he added. “Here we are in a crisis situation and the Number One concern that nonprofits have is they’re not going to be able to afford to stay open.”